Michelle Callahan, RN, BSN, CCDS, CRCR

Regional Manager, Clinical Documentation Integrity

Kaiser Permanente NCAL Revenue Cycle, Oakland, CA

Jillian Fore, RN, MPH, ACM

Clinical Documentation Integrity Senior Consultant; Former Interim Director, Clinical Documentation Integrity

Kaiser Permanente NCAL Revenue Cycle, Oakland, CA

CDI From Home? How to Implement and Maintain a Successful, Productive Telecommuting Arrangement

CDI From Home? How to Implement and Maintain a Successful, Productive Telecommuting Arrangement

The presentation will detail:• Policies • Procedures • Productivity expectations• How to manage relationships among the

team and with providers • Successful management of telecommuting

staff

Electronic Health Records

Economic Pressures

CDI work-at-home options

About Kaiser PermanenteNorthern California

• Founded in Oakland, CA, in 1945, Kaiser Permanente serves a diverse

population in Northern California

• Nationally, we currently serve 8.9 million members in nine states and the

District of Columbia

– Northern CA serves more than 3.3 million members in 21 hospitals and 233

medical office buildings

– We have 7,129 physicians and 74,985 employees, of whom roughly 65% are

represented by a labor union

• We have the largest civilian electronic health record in the world

• Kaiser Permanente’s approach to the CDI program supports two important

organizational goals:

– Our support for work-at-home programs is in keeping with our long history of

energy conservation and environmental stewardship

– KP is dedicated to being the best place to work, offering employees multiple

options for fulfilling their responsibilities

CDI: Growing a New Program

In the Beginning

Growing Pains

RethinkingInitial

Assumptions

• Regional program with regional accountabilities

• Place regional CDI staff in multiple local facilities

• Individual medical center characteristics

• Space challenges

• Staffing issues

• Interacting with local staff and physicians

• Day-to-day management

Ask ourselves:What was the TRUE benefit of having CDI staff located on-site?

Back to the Drawing Board

??

Who will do the job?

Where will the work be done?

Considertelecommuting as an option

Considerations:• Leadership approval• Technological requirements• Staff satisfaction• Go green!

Why should the work be done this way?

How will you support this model?

??

Telecommuting as a Win-Win

• Creating a recipe for success

– Intensive new hire training program

– Clear requirements around quality and productivity

– Practical tools and a safe work environment

– Detailed policies and procedures

– Regular connections and follow-up

• When possible, hire self-driven people with success working independently

Position “work from home” as an earned benefit, not a guaranteed benefit.

You Can Establish a Virtual CDI Function in Any Organization

Getting Started

Lay the Foundation

• Telecommuting policies and procedures

• Equipment

• Home office assessments

Establish the Framework

for High Performance

• Performance expectations and guidelines

• Signed telecommuting agreements

• Performance management/ improvement processes

Set Ongoing Performance

Expectations and Guidelines

• Ensure high performance before offering telecommuting as an option

• Support staff who require additional assistance

• Monitor performance trends

• Support staff performance with honest and timely feedback

Lay the Foundation

• Telecommuting policies/procedures

– Check with your human resources department to determine whether there are existing telecommuting policies/procedures

– Revise current HIM/coding telecommuting agreement/policy/procedure

• Equipment

– Determine which supplies/equipment your organization is willing to supply

– Identify a specific plan for IT issues

– Document accountability for damages to equipment supplied by employer

• Home office assessments

– Ergonomic evaluation

– Environmental safety assessment

– Adequate space/accommodations

Establish Framework for High Performance

• Clear department policies and desk-level procedures

– Recommended accompanying procedures• Absence notification

• Communication expectations

• Productivity and quality expectations

• Performance management/improvement process

• Telecommuting agreement

• Telecommuting procedure (including all requirements w/check-off list)

• Competency validation

• Provider query procedure/query compliance procedure

• Chart review completion

Set Ongoing Performance Expectations and Guidelines

• Productivity and quality

– Ensure high level of individual staff performance prior to allowing telecommuting

• Identifying performance opportunities

– Management monitoring of performance trends

– Ongoing discussion regarding comfort level and employee self-assessment of needs and areas of opportunity

• Supporting staff performance

– Give honest and timely feedback

• Training

– Initial CDI training

– Continuing education

• Work flow and workload distribution

– Begin with specific work flow

– Allow personalization as staff become more experienced

– Identify opportunities to assign work based on areas of program focus

• Relationships

– With providers and facility staff

– Build opportunities for engagement

– Develop incentives for physicians

• More relationships!

– With other team members

– Institute daily connections and opportunities for team building

Control the Things You Can Foster What You Can’t Control

Staying on CourseBuilding and Maintaining the Team

Staying on CourseManaging Across Distances

Management Adjustments

• Adjust management-to-staff ratio

• Clear, realistic performance expectations

• Make the extra effort to connect with individual staff members

Staff Adjustments• Goals include clear action plan

for performance• Take responsibility for education,

as needed• Remain connected to the home

site• Identify process improvement

opportunities

Performance and Data Sharing• Work hours• Identified performance metrics• Performance data

Retention Strategies• Career paths• Recognition programs• Incremental work-at-

home increases• Peer-to-peer kudos cards• Manager-designated

awards

Management Adjustments

• Staffing and responsibilities of management

– Will take more time and energy than traditional staffing; adjust management-to-staff ratio accordingly

– Establish and document clear, realistic performance expectations

– Make an extra effort to connect with each staff member regularly

Performance and Data Sharing

• Performance monitoring and communication

– Monthly review of work hours (through electronic systems)

– Weekly or monthly review of designated performance metrics

– Facility- or service-level performance data (response rate drilled down to provider level)

– Consider blind performance data sharing

Retention Strategies

• Consider promotional level within organizational/departmental structure

• Increased accountability and additional responsibilities/special projects

• Employee recognition program

• Incremental work-at-home increases

Staff Adjustments

• Increased staff accountability

– Clear action plan for performance under goals• Education

• Returning to home site

– Staff responsibility to identify process improvement ideas

Potential Pain Points

The Right People• Self-driven with high

levels of personal accountability

• Professional• The right experience• The right temperament• Skilled communicators

The Right Places• Proximity to home facility

The Right Sponsorship• From regional leaders• From local leaders

The Right Systems & Support• Downtime procedures• IT escalation plan

The Right Performance Management System• Performance feedback• Ongoing communication• Data sharing• Remote education and

mentoring• Implement staff ideas for

improvement

The Right People

• High level of personal accountability

• Professional

• Autonomous

• Chart review experience

• Experience and success with high-volume/high-stress work environments

• Ideally not straight from inpatient floor nursing

• Expertise at public speaking, education, presentations

• Previous experience within the facility

• Previous experience with electronic heath record and high level of comfort with basic computer programs

– Consider new employee testing in this area

The Right Sponsorship

• Gaining approval and acceptance

– Leadership• Thorough and thoughtful plans prior to presentation

• Utilize current organizational goals and initiatives to support this work model

• Consider a trial

• Regular performance feedback

Michelle Callahan, RN, BSN, CCDS, CRCRRegional Manager, Clinical Documentation IntegrityRevenue CycleKaiser Permanente, Northern California RegionMichelle.L.Callahan@kp.org

Jillian Fore, RN, MPH, ACMSenior Consultant, Clinical Documentation IntegrityFormer Interim Director, Clinical Documentation IntegrityRevenue CycleKaiser Permanente, Northern California RegionJillian.S.Fore@kp.org

In order to receive your continuing education certificate for this program, you must complete the online evaluation which can be found in the continuing education section at the front of the workbook.

Questions?